Artesunate/mefloquine treatment of multi-drug resistant falciparum malaria.
On the western border of Thailand, in an area endemic for multi-drug resistant Plasmodium falciparum malaria, therapeutic responses were assessed in 1967 patients with uncomplicated falciparum malaria treated with 3 d of artesunate (total dose 12 mg/kg) plus mefloquine (total dose 25 mg/kg). The regimen was well tolerated and resulted in a rapid clinical response; within 48 h, 96% of patients were aparasitaemic and 94% were afebrile. After correcting for reinfections, the cure rate by day 42 was 89% (95% confidence interval [95% CI] 87-91%). Three independent factors were found to predict recrudescence: age < 14 years (adjusted hazards ratio [AHR] = 1.6, 95% CI 1.1-2.3), initial parasitaemia greater than > 40,000/microL (AHR = 1.6, 95%, CI 1.2-2.2), and pure P. falciparum infections (AHR = 1.8, 95% CI 1.3-2.7). These 3 factors combined accounted for 62% of all treatment failures. Patients who received mefloquine on admission with a high admission parasitaemia (> 40,000/microL) had a three-fold (95% CI 1.3-7) risk of subsequent recrudescence compared with those who received their mefloquine on the second or third day (P = 0.01). There has been no decline in the efficacy of the 3 d artesunate plus mefloquine regimen since it was introduced in 1992. This regimen is safe, well tolerated, and highly effective in the treatment of multi-drug resistant falciparum malaria.
Price
R N
RN
Shoklo Malaria Research Unit, Tak Province, Thailand. 101507.3605@compuserve.com
Nosten
F
F
Luxemburger
C
C
van Vugt
M
M
Phaipun
L
L
Chongsuphajaisiddhi
T
T
White
N J
NJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use*; D037621:Artemisinins; D000077332:Artesunate; D002648:Child; D002675:Child, Preschool; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination; D019353:Endemic Diseases; D005260:Female; D005334:Fever / Q000188:drug therapy; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D015767:Mefloquine / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D018512:Parasitemia / Q000188:drug therapy; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012717:Sesquiterpenes / Q000009:adverse effects / Q000627:therapeutic use*; D013785:Thailand; D016896:Treatment Outcome
D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D000077332:Artesunate; D015767:Mefloquine